Provider Demographics
NPI:1336258482
Name:PANTALEO, MARYJANE (NP)
Entity Type:Individual
Prefix:
First Name:MARYJANE
Middle Name:
Last Name:PANTALEO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 HARBOR VIEW PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3909
Mailing Address - Country:US
Mailing Address - Phone:718-448-5013
Mailing Address - Fax:718-448-7806
Practice Address - Street 1:275 CASTLETON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2709
Practice Address - Country:US
Practice Address - Phone:718-447-7800
Practice Address - Fax:718-448-7806
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33-332630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily